Medicare Nurse Compliance Consultant

Join a team of dynamic professionals providing compliance and privacy services in the Life Plan/CCRC and post-acute environment. Great opportunity for professional growth and development.

The Medicare Nurse Compliance Specialist performs on-site compliance reviews and audits for a diverse group of organizations providing services in multiple states.  

• Conduct reviews and audits that encompass a variety of subject matter, including those surveyed under State and/or Federal regulations or laws with a focus on clinical services, including professional standards of care.
• Assist with ensuring compliance with regulatory requirements associated with the Centers for Medicare and Medicaid Services (CMS), Office of Inspector General (OIG), Office of Civil Rights (OCR), the Health Insurance Portability and Accountability Act (HIPAA), and state regulatory authorities.  
• Review medical records, billing and associated supporting records to validate accurate comprehensive documentation that substantiates the medical necessity, quality of care, utilization of therapy services, and coding of claims associated with Medicare and/or Medicaid reimbursement.
• Assist with implementing recommendations or changes as necessary, including education and training, developing clinical and operational policies and procedures, and guiding implementation of the organizations, systems, or services that enhance organization compliance.

Essential Duties and Responsibilities

• Perform Medicare compliance audits for organizations in areas surveyed by State and Federal regulation and law.
• Assist with ensuring compliance with Medicare, Medicaid documentation, coding and billing rules and HIPAA regulations.
• Assist in monitoring the activities and regulations of the Centers for Medicare and Medicaid services and various state Departments of Health.
• Contribute to the development and implementation of programmatic changes and development and provision of participant support through email and phone contact.
• Travel to offsite locations. Overnight travel is required.

Desired Skills & Experience

• Minimum of 7 years’ experience in the Long-Term Care, Post-Acute/Healthcare industry. Experience with documentation, coding and billing for Part A services a must.  
• Bachelor’s Degree: Nursing and RAC-CT Certification.
• Extensive knowledge of Medicare and Medicaid Coding and Billing in the post-acute environment.
• The ability to be flexible and adapt to changing regulatory environment is a must.
• Strong written and verbal communication skills.
• Ability to travel and work independently.

About the Friends Services Alliance Collaborative

The FSA Compliance Collaborative is committed to ethical conduct that enhances the quality of service and care to residents/clients of participating organizations and protects their reputation and assets through the implementation and support of compliance and ethics programs and privacy programs in the senior living environment.  

Friends Services Alliance (FSA) is a nonprofit organization that provides support to values aligned organizations for older adults. FSA administers a collaborative program of compliance services called the Friends Services Alliance Compliance Collaborative.

FSA offers a collaborative environment and competitive pay. Interested parties should send their cover letter, resume, and salary requirements to Karla Dreisbach.

For more information about FSA, visit fsainfo.org.

All interested candidates can apply.